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Thursday, August 9, 2012

Can Women Have It All? Depends On How You Define All.

I just finished the just profoundly awesome article Why Women Still Can't Have It All by Anne-Marie Slaughter, in this month's Atlantic. This is the article that has all the buzz going about professional women and work/life balance.

It has taken me a full week to finish this article, reading in bits and snatches before work, between patients and after work. I finally got through all 6 pages. Totally worth it. She says what I have been feeling and trying to voice to the women coming up the ranks of training in medicine.

Though I disagree with one fundamental point. She feels that most women can't Have It All, and by All seems she means breaking into the higher echelons of their professions, making the highest possible achievements. I agree with her on this.

My feeling is that All can mean something else. All, to me, means achieving total personal and professional fulfillment. And this does not have to mean being the CEO/ Secretary of State/ Department Chair/ Nobel Prizewinner.
When I am asked advice by pre-meds or medical students considering a career path, I hedge my response based on their answer to my questions-- "Do you have or want to have a family? And do you want to spend time with them?"

There are few professions that require as much schooling as medicine. It took a long time for women to get into those schools, to break into the profession. Women now comprise 50% or more of the students entering medical schools. However, we still don't see many women in positions of power in medicine or in certain subspecialties. While women in medicine has been a long time coming, women in power positions in medicine, and women in certain subspecialties, may be a long time coming yet. The basic reason? The paths to those positions mean too great a sacrifice at the expense of a family.

I wish I could say to any of these incredibly bright, hardworking, determined women that "Hey, with enough brains and hard work and determination you go anywhere in medicine!" But that's bull, and Anne-Marie Slaughter says so in the pages of the Atlantic.

But they can have it All.

If All means achieving personal and professional fulfillment, of finding that elusive work/ home balance, then I'd say, it's entirely possible, but think it through very carefully. Look to the future- Look to the women who are working and practicing doing what you want to do. What kinds of positions are available? Is anyone working part-time? Are family values promoted and respected? Would you be expected to be at work and working endless hours? Is there a lot of call? Would you need to go into the hospital unexpectedly? Etc etc.

If women have or envision having a family someday, I ask them to think really hard about the kind of life they imagine. What kind of a partner do they or will they have-- is this someone who can stay home when the baby is sick/ it's a snow day/ there's an unexpected holiday/ they are sick? What kind of partner and mother do they want to be-- do they want to be present, participating, reassuring, enjoying family dinner, tucking in? If so, can that vision fit with the lifestyle of the specialty they're considering?

When I was interviewing for jobs four years ago, I had just come out of a research fellowship, and I knew that life wasn't for me. Very competitive, getting those grants. I also saw women MDs who aspired to be Heads of Something, or Experts in Something Else, and I knew I didn't want to do that either. I knew I wanted to focus on family as my priority, and to work part-time at a clinical practice with a good "vibe": supportive, flexible, mom- friendly.

I had to really search. I hired a professional job headhunter guy. He kept sending me listings. Some places wanted me to work 10 clinical sessions a week! Others had 1 week of call a month. Ugh.

Now, I'm a part-time internist, with two little kids. I was lucky to have found work in a small, progressive practice, 5 sessions a week, with 1 week of call every 3 months. The vibe? Well, just this morning, I met with my practice head and explained our situation:

Our two-year-old isn't talking. He's been diagnosed with severe delays in receptive and expressive communication, as well as some cognitive delay. He's eligible for all kinds of services. We'll be taking him to speech therapy and group therapy at least... and before that, he needs hearing testing, a developmental eval, etc. We'd also like to get him into some other activities to help him start communicating. This will all take some time, and time involves rearranging my work schedule. Like, dropping my Friday afternoon clinic.

My boss was great. There was no issue here. The support was 100% there.

All, to me, is where I am. Yes, I had to search this place out. Yes, there is tweaking here and there. I'll be glad for a promotion and a raise when it comes. I'll be glad for some adjustments to my schedule; a decrease in clinical time and an increase in admin time. Work sometimes edges into home, and home into work; I think that is natural and inevitable. But I consider all of that to be fine-tuning of an otherwise really excellent arrangement.

Can All be as easily achieved in all the areas of medicine? I don't think so, not yet. So my advice to those making their way up the ranks is to think about what will bring you personal and professional fulfillment, and to work towards a healthy work/ home life balance.

It may be that practice arrangements like mine in medicine are few and far between, but I see them popping up here and there in primary care. Where they are not, then shift work, as in Emergency or Hospitalist work, may be far more inviting to the aspiring physician-mother.

But maybe someone is driven to be the Head of a Department or the Expert in Something, and they feel they will not be happy or fulfilled until they have made the achievement; AND they want to have a family.... In that case, I think the choice of a partner, living close to extended family, and a very organized schedule could help... Personally, I don't believe that these external professional achievements give one true life satisfaction. I think many of us start off thinking they do, and hope they do, but then realize, they don't. Family does.

My way of seeing this: I was trained to do a hard job that I loved. I also wanted to have a strong, healthy family. So for me, I chose carefully. Now, I am doing the job I trained to do and that I love, I do it well, in a great hospital and positive environment. I also spend alot of quality time with my two little kids and my husband and my extended family. "Alot" to me is what I need. I get the time I need with my family.

So I feel very lucky. I have it All. I think we all can, even in medicine, but it takes looking to the future, thinking hard, being honest, and choosing carefully.

first, thanks for sharing your views and experience. it's nice to know that the kind of environments i hope to find someday are out there, infrequent as they may be, and that working in a solid work-life balance is truly fulfilling and not just a feeling of compromise.

second, some typos in the penultimate paragraph. see here: http://hyperboleandahalf.blogspot.com/2010/04/alot-is-better-than-you-at-everything.html =)

Thanks for a thoughtful piece about how you have found a good balance in your life. But when you are giving advice, remember that there are numerous ways to find balance in life and to find work that is fulfilling. I'm a clinician, an Associate Dean (faculty), a researcher, a mom, and a wife. I love my life. I love the opportunity to help faculty find success. I love watching my daughter in sporting events and concerts (I make it to most of them, even when they are a 2 hour drive away). I love going out to dinner with my husband. I love being a role model for the future I'd like my daughter to have.

How do I make it work? 1) husband who views my success as his success and is my best cheer leader; 2) husband who contributes at least equally (he is self-employed and travels frequently but when he is home he does the errands); 3) hiring out the work: yard care, repairs, nanny / personal assistant who drives our daughter to and from school and runs errands for us like dry cleaning and grocery shopping and car repairs; 4) cutting corners when they don't matter so I can do the things that do (I buy pre-sliced everything and don't care if my house is perfect- this leaves time for making cool birthday cakes and Halloween costumes for my daughter) and 5) feeling that the more people my daughter loves the better off she is, and it shouldn't be me putting her to bed every night, and 6) not feeling guilty or the need to be perfect at everything. And of course, sometimes it doesn't quite work, but in the end that's okay, too.

hh -- Thank you so much for your comment. I agree that family is extremely important, but there are other things that are also important to my happiness, and without them my happiness and therefore also my family would suffer too. Thank you for showing us a glimpse of your "all" too and how you've made it work for you and your family.

I am a 41 yo single, OB/gyn who maybe wants kids someday. I read this website to see what my future may hold. It would be really hard to achieve your lifestyle as a Ob/gyn. I don't even know what part-time would look like. My BFF is also a Ob/Gyn, but she's married with 2 boys, 4 and 8 years old. She is a a full time partner in her practice located 2 miles from her house. THe hospital is connected to the hospital. Her husband has a less intense job, but sees taking care of his kids as baby-sitting, requires a hot meal each evening (but refuses to either cook or purchase said meal himself) and spends money like there's no tomorrow despite his substantially less salary. My friend hired a live-in nanny to help with kids so whenever she can't be available someone else can watch the kids. HEr hubby is generally home each night. They recently terminated the nanny and her life has gone to hell. I never criticize her home life, because it is her life and her marriage. I just listen and offer her whatever support i can while living in a different town.

I think we should be honest and say like the author of the NYT article, you can't have it all. I never imagined I would be single and childless at this stage of life. I chose to focus on my career and it came with consequences. I take personal responsibility for that. You can say that you have it all, but is your life now how you envisioned it at 18, 25, 30 or 35 (not sure of your age)? Probably, none of us has the life we envisioned.

I think we should be honest with pre-med and medical students by saying that medicine can be a very rewarding career, but it comes with sacrifices, both good and bad. The sacrifices you make as a private practice dermatologist are going to be very different from the ones you may make as a neurosurgeon in academic medicine.

Neither of my parents were physicians. If I knew as a 22 year old the things I now am aware of, I feel like I would be in a different place personally and professionally. Life is good and I take comfort in knowing that I am where God wants me to be. But somedays after I have been up all day and night delivering other peoples babies, I wish I was going home to my own family.

Also wanted to add a bit about taking time off. I cannot imagine going to my bosses and asking for time off to take care of a sick child. After not having any real vacation for 4 months (even with sick/vacation time banked), it took a doctor's note and FMLA papers to get 5 days off.

I think your friend is in a shitty marriage. But as for the rest of what you say, I think its true, the pursuit of a "high powered" or professional career does generally come with personal scarified and not everyone is fortunate to find partners who understand the specific demands (i.e. pagers) of medicine. I personally don't know if I hadn't met my husband when I was 18 if I would have met anyone in medical school or thereafter, but of course whose to know. I have a few single physician friends who say it is very difficult to date non physicians because trying to explain yourself involves trying to explain your training and its demands and that can be just too complicated.

I appreciate your posting very much. I have very different feelings on the "having it all" issue now as compared to how I did when I started my training.

I work part-time as an ob/gyn at a health center. I see patients in the office for 20 hours per week and take call about 4 times per month. My OR time comes out of my office hours and also on call days, though I have the option of operating on my days off if I so choose. Tradeoffs: I don't do enough hysterectomies annually to train on the robot. I sometimes lose patients to my full time partners when it's too hard for them to get an appointment with me. I sometimes feel a little twinge for the academic career I once thought I'd have, especially when hearing about the achievements of some former residency colleagues. Considerable advantages for me: plenty of time at home with my two kids and increasing responsibilities for helping with aging parents. I'm learning to play the piano. I have time to keep up on my reading. I love the balance I've found- it works well for me. I also know a single ob/gyn who had a similar part time position due to other interests/responsibilities- it's not just parents who long for that work/life balance.

Thanks everyone for taking the time to read and comment. To hh. The Associate Dean, I think that is wonderful! I am very curious what area of medicine you trained in/ practice. I suspect one of the primary care specialties, wheer I see the most progress in work/life balance in medicine has been made.... Also you exemplify the importance of choosing a life partenr well. You obviously chose well!

Actually, Genmedmom, I'm an anesthesiologist, as far away from primary care as I could get. :-) You are so right that the partner makes all the difference! Here's things that I think made a difference for me:1) the on / off nature of anesthesia. I always have had a reduced clinical commitment, 1.5 to 2 days a week. For 15 years, I made up the difference with NIH grants and now it is funded from administrative salary. 2) doing stuff I really, really love. I should have probably put this first. Anesthesia is just a lot of fun (for me); I love preparing for cases, and sticking people with needles, and making decisions on the fly, and giving blood, and watching the physiological impact of drug administration. I chose an area of research that was a niche and not recognized (what is the impact of anesthesia on surgical site infection?), but fascinated me and allowed me to make contributions at my own pace. Then I slowly segued into teaching residents / junior faculty how to do research and career mentoring. I live to give advice, so I never get tired of it. I see people making choices based on life style or other considerations, and i think that is risky. If you don't love what you do, it's harder to stay committed when you love your kids.3) The academic life is very flexible, especially with a research component. I did swim lessons every Wednesday morning with my daughter from the time she was 3 months old until they promoted her into the regular swim class when she was 2. Special time, and no guilt because I spent plenty of nights and (to a lesser extent) weekends collecting data. I often took my daughter with me to meetings, either bringing along our nanny or having my mom meet us and take care of her.4) I had money to throw at making my life simpler. I met my husband as a 3rd year medical student-- he was a business school student and we got married just before I started anesthesia residency (after a year of surgery and 18 months of research). We lived on half of his salary and spent all of mine (pathetic though it was) and half of his paying off our student loans, which were substantial). Our apartment was very student-like, but we paid off all our debts 7 years after graduation. Then we started thinking about having kids (okay, first we took a year and traveled around the world to celebrate). So we have always had a lot of help, which means time at home is largely time with family. And yes, I worry about what this teaches our daughter about being self-sufficient, because it is a parent's job to worry. 5)Waiting to have children and then only having one. Although I know very successful people who have done it every which way, this is what worked out for me. And I recognize the risk I took by waiting (I was almost 38 when my daughter was born), but it turned out not to be an issue for me, so I was lucky. Of course, I came up for tenure 6 months after my daughter was born, so I was able to maximize the stress in that regard. There's always something. We had a great panel of women a couple of years ago-- all successful academics, with 1 to many children starting young and old, and the clear story was you have to find what works for you.

6) I found parental leave kind of stressful (I took twelve weeks), and I recognized early I would not at all enjoy dedicating my life to raising a child. I liked the idea of a fresh person to take her and tire her out everyday. Our nanny was amazing. And I always felt that the more people our daughter loved the more she'd be able to love, so I didn't have that common anxiety. Newborns are, frankly, kind of boring. And mine ate 60 minutes out of 90, which was a bit overwhelming. She did sleep 7 hours the first night home, and was doing 12 hours by the time she was a month old. Which is another thing. It really helps to have an easy child who is never sick (she has stayed home from school sick one day in 10 years), mostly happy, and likes to entertain herself. We were still on the edge of the cliff, so I can imagine how hard it would be to have a more challenging / demanding child(ren).Okay, a lot of info. Sorry. To wrap up:Our family motto is: 'you can have anything you want, but you can't have everything you want.' I think the key is to choose the anything carefully because then the everything isn't as hard to give up. And to cut as many corners as you can on things that don't matter. And not to listen to all the advice you get on what makes a perfect mom / physician, because you are the one who has to figure out what works for you. Except, of course, you should listen to my advice. :-)

and to gossipgilr1, don't give up, but rather, work towards your real dream. You can have a partner and a family, if that is what you really want out of life. I truly believe that. You may need to work at a different practice, maybe take time off, or move to an area with more options... but worth it, if it can help bring you what you really want in life! Good luck.

Could not have said this better myself. The key is defining your own "ALL", and redefining it as your life evolves.

I am a part-time FP (25-30 hours/week), in practice with my husband and FIL. We have three young children and it is a constant balancing act (or more like plate spinning), but I feel I am is close as I can be to my version of "having it all."

I often see-saw between feeling that I am neglecting aspects of family or work, but how could it be any other way? These are both all-consuming roles, and to think women can do all of these things at 100% (or 150% as I know we secretly aim for) all the time is an unfair expectation to put on ourselves.

Could not have said this better myself. The key is defining your own "ALL", and redefining it as your life evolves.

I am a part-time FP (25-30 hours/week), in practice with my husband and FIL. We have three young children and it is a constant balancing act (or more like plate spinning), but I feel I am is close as I can be to my version of "having it all."

I often see-saw between feeling that I am neglecting aspects of family or work, but how could it be any other way? These are both all-consuming roles, and to think women can do all of these things at 100% (or 150% as I know we secretly aim for) all the time is an unfair expectation to put on ourselves.

Hm, if we told family-minded women 30 years ago that they'd never make it as a doctor and mom....they'd never have applied to med school and never would have become the role models I have today. The glass ceiling would still be "getting in to med school". Now the glass ceiling is "becoming department head". It's true that ambitious moms like Slaughter pay the price--but the people who get the benefit are the next generation. I feel like I especially am reaping the benefit of women before me, as I matched in a competitive specialty that has become more lifestyle-friendly over the years. (Thanks, ladies!)

I think it's important to be honest and practical with prospective mama-docs, but I also think it's pretty awesome to sit back and see what the next generation can do, especially if they can work out a set-up like hh has. Women in high-powered positions benefit all of us. I don't know yet if I'll fall into the high-powered or low-powered camp, but I'm glad I have women role-models on all ends of the spectrum.

Also: I "have it all" because I love and am loved--no career or family required.

Thanks for your post. I found it encouraging, as a young female doctor (married, planning a family) who often feels conflicted between the desire to have a successful career and thereby 'fulfill my potential' (aren't all girls taught to do that when growing up?) and to have a balanced life with time for other pursuits. I sometimes wondered why I was not more like many other female doctors at my hospital, who seem to not be bothered by the long hours and shifts, and are so focused on developing their career. Although I did better than many of these people at medical school, I know that their careers are on track to be much more successful. I wondered if I was simply lazy or too uncommitted to medicine. Your article reminds me that having it 'ALL' in career and having it 'ALL' in overall satisfaction/fulfillment are two different things, and while society may value the first, what is important to me should be the second. It's still an ongoing struggle to be reminded of this though :-)

I am a mum of 4 and a junior doctor and I have just gone back to work from maternity leave. I love my job but find it hard to balance the guilt of loving my job. A male colleague once said to me, "why bother having children if you're going to work?" He wouldn't have dreamt of saying that to a man. I decided from that moment I would do whatever the hell job I wanted, and then fight to make it more mother friendly. Not settle for something I don't really want to do because the hours are good.

And I am totally going to ask my nanny to become more of a personal assistant. You are a genius.

Here I am, 9pm, both kids are finally in bed, and I am procrastinating this "revise and resubmit" research article, as I question the pros and cons of a research life, part-time career, and leaving academics. It is so refreshing to hear you have found a balance. There are so many struggles!

Your practice sounds enlightened and progressive. As I consider leaving academics, I was wondering if you might write or post something about what to look for in a part-time/family friendly position. I think your experiences would be super helpful to those of us searching for something similar.

Thanks for the post on this article. I loved the article, and forwarded it to several friends, including one woman colleague who basically road-blocked me from joining the practice because I wouldn't take inpatient call. We have SUCH a long way to go to achieve equality of the sexes. This is such a nuanced problem.

We live in a culture in the United States that has a "me! me!" way of thinking. Regardless of gender, men and women both need to take a chill-pill when it comes to identifying one's self by achievement. Instead of having the thought process of achieving things for one's self and filling your own personal trophy-case, what happened to servant-hood? Being a full time mother or even a stay-at-home father is MORE valuable than becoming the next Dr. Ben Carson. When one chooses the attitude of servant-hood and isn't focused on personal achievement, they will then find themselves in a higher place with a higher calling. I'm not against women having lofty medical/career achievements-- but they just need to realize that there's sacrifices one way or another. You will not be happy until you make a sacrifice.

Thanks so much for this, it's like the argument in my head. I'm starting the second year of my cardiology training and I'm stuck at this cliched cross roads. Having a baby has certainly shifted the balance and the decisions all seem to come at once. Subspecialise and have my daughter 'love lots of people' or shift my focus and opt for quantity over quality time? Can I conquer Academia later? Is it now or never? Because her early years as well my fertility, despite our best scientific efforts, are limited-time-only. Ironically we had a guest speaker at grand rounds this week tell us we can and should have it all. Head of a major research funding body, practicing clinician in EP at a major academic centre, resident mentor and.....father of 2. His wife quit work as a nurse when they got married and he's achieved his 'all'. The devil's in the detail and the definition. I have the '1950's house-wife' husband (and his sent-from-heaven mother), no lack of support. It's less sexism/glass ceiling and a lot of scientific fact and co-incidence of training and reproductive years. This posting is very helpful. It's all down to your definition of 'all'. I feel like mine is changing. Maybe I'm more 'old fashioned' than I realised when I was single and single-minded. Am I wrestling my inner 15yr old who was a future president of the universe? Am I giving up on my dreams? Were they well-defined enough to begin with? Am I making new ones? In some ways it's liberating to think I don't have to keep pushing. I can do whatever I want. I just need to figure out what that is and make sure I'm not living for my 'trophy cabinet' and my list of boxes to tick. Maybe if my academic career is meant to be, opportunities will still be there to work for later on and I can have it 'all' and then 'have it all'. Whatever you choose ladies, you're all amazing.

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